Biopsy was INCONCLUSIVE?!

LMoon

(backstory-- I'm 26 years old with a history of benign breast issues and a strong family history of BC. At a routine ultrasound earlier this month they found a suspicious area, mammo confirmed two areas of calcifications)

I had my stereotactic biopsy on Tuesday and my results were inconclusive. How is this even possible?

One area came back as benign, which we expected (they rated it a 2 out of 6 on some scale I'm not familiar with). The other area, which was the highly suspicious area, also came back as benign. However, the doctors at the breast clinic don't actually believe it's benign, they believe they just got a bad sample. They seem quite convinced that it's BC. They're having a conference tomorrow with all of the doctors at the breast clinic (radiologists, surgeons, oncologists) and they're going to review my case together to come up with a plan. They are going to call me tomorrow with that info.

Has anyone else been through something similar? This is insane to me. I just need answers!

MelissaDallas

Usually this is called "discordant" results and they excise the area in a surgical biopsy to be sure. You can do a search on discordant results here. There have been quite a few posters who had this happen.

LMoon

Ah, thank you for that information! That's good to know.

moth

Remember pathologists are looking at tiny samples and examining single cells. It's hard to tell what things are sometimes & part of it is a judgement call.

There's an interesting 2015 study about this which said "overall agreement between the individual pathologists' interpretations and the expert consensus–derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia" I found another part of this study interesting too. They had 3 *expert* pathologists who reviewed the images and they were in accordance 90.3% of the time; I was a bit taken aback by the ~ 10% disagreement rate among the experts.

https://jamanetwork.com/journals/jama/fullarticle/...

(btw, I can't display their articles well in my browser as I never get the left split screen scroll bar so I end up downloading the pdf instead...just in case you want to read the whole thing & it doesn't display right...)

here's a sample of images they were looking at & you can see that it varied how each was interpreted

All of this makes me feel better at how I struggled with identifying some tissue samples in my anatomy & physiology classes but also makes me a bit more cautious about pathology results. They're not always right.

LMoon

This is fascinating! Thank you for sharing. I had no idea it was so subjective.